Occupational Therapy (OT) is a health care profession that provides services to people whose ability to function in daily life has been disrupted. Purposeful activity, therapeutic exercise, special equipment, skills training and environmental modifications are used to maximize the person's ability to attain independence in everyday living (BOTA definition, 2010).
The Occupational Therapy Department at CRP has grown to accommodate 38 staff members, who work across both academic and clinical services. Clinical Occupational Therapists (OTs) work in the following areas:
An outpatient OT service is provided at CRP that includes evaluation, treatment and education after an accident, illness or injury. The goal of OT is to enable an individual to carry out their activities of daily living, which include those performed at work, home, school and the community, as independently as possible. Following a thorough evaluation, which includes an assessment of physical function, cognition, perceptual and daily living skills, if appropriate, an OT will tailor a treatment plan dedicated to restoring a patient's maximum functional ability.
Treatment Approach - A variety of treatment techniques are used by the OT, including adaptive equipment, self care retraining, cognitive, perceptual and therapeutic exercise. The treatment program is designed based on the assessment and the specific goals of each patient. It may consist of the following activities:
Range of motion and strengthening
Fine and gross motor activities
Home and community training
Adaptive equipment training
Who can benefit - Our therapists treat people with a wide range of conditions, including:
Orthopedic conditions: Upper limb injuries, trauma, shoulder pain, sports/work related injuries, fracture or sprain, arthritis, lymphoedema, osteoporosis, hip and knee joint replacements.
Neurological conditions: Stroke, acquired brain injury, spinal cord injury, multiple sclerosis, Parkinson’s disease, guillain barre syndrome, amyotrophic lateral sclerosis, muscular dystrophy, adult cerebral palsy, cognitive disorders.
Our Staff - The Outpatient Rehabilitation Centre is staffed by a team of highly skilled and licensed occupational therapists. Specialists on staff include:
Trained Hand Therapist
Certified Bobath Therapist
The CRP Paediatric unit provides two services - an inpatient service and an outpatient service. The Occupational Therapists work with a multidisciplinary approach with many different professions (Paediatrician, Physiotherapist, Speech & Language Therapist, Orthopedics, Nurses, Social Welfare unit, special seating, Orthotics & Prosthetics).
In-patient Service - This residential program provides two weeks intensive services for 21 children, most of whom are children with cerebral palsy. This program is designed to integrate children with disabilities into their own family and community. The aim of the therapists is to maximize the child’s ability to attain independence in everyday living and to improve quality of life. Therapists educate the mother about the child’s condition, and teach them how to take care of the child at home. In this two weeks the mother and child are involved in different group therapy, individual and combined treatment sessions and an educational program. Some of the OT programs include; morning group therapy, hand therapy, feeding, dressing and toileting classes, parents meeting, play therapy, and sensory integration therapy. Within these two weeks the OTs also prescribe and provide assistive and adaptive devices according to the child’s individual needs, eg. splints and special seats. On the final day of the program the OTs provide a booklet of the treatment program for the Mother to refer to once at home. On discharge patients will return to outpatients for follow up.
Out-patient Service - The OTs also provide an out-patient service to follow up patients' treatment, with an average of 30 patients each day. This service is usually for children with conditions such as cerebral palsy, autism, down syndrome, behavioural problems, intellectual impairment, muscular dystrophy, erb's palsy, club feet, flat feet, and congenital deformity. Every patient receives a one hour treatment session, with the OT planning the intervention with the child's family according to the individual needs. Once a fortnight, there is also an autism therapy group conducted by the OT.
In-patients - Spinal cord injury
The Spinal Cord Injury Unit is in-patient only. It consists of 108 beds, with 12 wards (one post operative ward, one female and ten male wards, this is due to the majority of spinal cord injuries occurring in young males). The majority of spinal cord injuries are cause via fall from height or tree, carrying heavy loads on head, diving into shallow water, heavy objects falling on their back, or road traffic accidents. Rehabilitation following a SCI consists of four phases:
Acute: OT Interventions include positioning, splinting, hand therapy, psychological support, pain management, introducing leisure activities, and Carer education.
Active: OT interventions include functional bed mobility, transferring, wheelchair mobility, introducing functional activities, splinting, hand therapy, and participation in art & song classes.
Rehabilitation: OT interventions include retraining ADLs, advanced transferring, functional mobility, wheelchair assessment & advanced wheelchair skills training, prescribing assistive devices & modification, vocational assessment, education, and addressing spirituality
Community reintegration: More details are provided on this phase in the next section.
Ward-1 is seen as the most acute through to ward-11 which is preparing patients for discharge. The inpatient service provides occupational therapy across the first three phases. Following discharge from the hospital setting the patients spend a further two weeks in the half way hostel. The halfway hostel is an environment which prepares the patient for community integration and further develops the skills to live in the community with a spinal cord injury. More information on this service is discussed in the next section.
Advanced Skill Training - The OTs play a vital role in increasing people's functional skills and abilities, enabling them to spend leisure time in a fruitful way. In April 2010 the OT Inpatient Unit started some exciting advanced skills training for SCI patients. Bracelets, earrings, friendship bands, handkerchiefs, wall mats, jute hangers and different ornaments are made in these classes, and then sold. The purpose of the training is to improve patients' hand skills, self confidence and opportunities for socialisation. OTs select patients from bed rest, active and rehabilitation phases to help them improve their skills, self confidence and to help pass their time meaningfully. The Executive Director of CRP formally opened the program.
Community Reintegration Program/Halfway Hostel
The halfway hostel is located on the CRP Campus and is designed to replicate the home environment on discharge. This is a place where patients with a spinal cord injury (SCI) who are being discharged from hospital stay for at least fourteen days to improve their coping and adjustment ability. The aim of the program is to facilitate independence and coping skills in a person with SCI in preparation for successful integration into the community. The OT coordinates the activities in the program, which include:
Home exercise/therapy (group and individual)
Home and workplace modification classes. The OT will then conduct individual planning with patients to tailor the home/workplace modifications required for their specific environment.
Psychosocial adjustment groups (including stress management, spiritual counseling, positive thinking education)
Personal ADL (activities of daily living) practice (showering, dressing, eating, toileting), modification and equipment prescription. The OT will also do transfer practice to/from wheelchair to toilet, bed, chair etc.
Domestic ADL practice - including gardening, farming, & cleaning. The OT may modify these activities and provide assistive devices according to the individual's needs.
Community ADL practice - shopping, transport, group visit to the National Monument.
Education on the prevention of complications (pressure sores, urinary tract infection, joint stiffness)
Future planning - individual and group classes to ensure realistic goals are set for returning to their home.
Relationship education - for friends, families and couples.
Special Seating clinic
This clinic provides a detailed seating assessment to children and adults with a variety of conditions (cerebral palsy, muscular dystrophy, stroke, acquired brain injury). Following this needs assessment, postural supports and modifications to wheelchairs are then completed to provide the client with the best possible posture in which they can carry out their daily tasks comfortably. Clients undergo a trial of these modifications where further modifications can be made if necessary. Wheelchair modifications and postural supports are all designed and manufactured on-site. Optimal positioning for these clients will also assist in preventing complications, including contractures, pressure sores and scoliosis. Ongoing, lifelong follow up is provided to these clients.
Work Rehabilitation Program
CRP's innovative Work Rehabilitation Program is conducted by the Occupational Therapy Department. The program was established in 2002 with the support of the United States Department of Labor (USDOL) to help people with a spinal cord lesion to return to their previous work. Each month, 2 patients are chosen to be involved. The physical skills necessary for their work are identified and therapy is targeted to these skills. In addition, adaptations to the physical workplace environment are made by the therapist. A follow up visit is conducted in their workplace to assess the progress of these interventions.
Vocational Training Assessment
This service is for patients with a spinal cord injury ready to re-enter the workforce. The Occupational Therapist completes a detailed assessment with the client, including:
After assessment, the OT decides in conjunction with the client whether they are suitable for specific vocational training. This is discussed with the vocational trainer and the client is then referred if appropriate. Vocational training can be provided to clients in the areas of tailoring, electronics, shop management and computer skills. The OT, in liaison with the client and vocational trainer, can provide any environmental modifications and assistive equipment to improve their skills and independence in the tasks if required. Regular follow up and communication with the client and vocational trainer is provided.
The hand therapy outpatient unit was set up in 2008 with the help of Interplast Australia & NZ. Some common conditions seen are fractures, de quervain's, tenosynovitis, carpel tunnel syndrome, trigger finger, tennis elbow, nerve injury, tendon injury and burns (mostly chemical burns). There are more traumatic injuries over progressive conditions like arthritis. The main assessments used are:
Muscle strength using the oxford muscle scale
Range of movement with goniometry
Grip strength using a dynamometer and pinch gauge
Sensation using microfilaments and two point discrimination
After assessment, a problem list and a plan is formed. The Occupational Therapists at CRP make all of the splints. Due to shortage of materials, resting splints and cock-up splints are made out of a material called 'plastic-wood'. An electric saw, heat gun, a stanley knife, and sand paper are used to make and mould them. When there are donations of splinting materials from overseas thumb spica splints, MPC hyperextension blocker splints, finger splints and other splints can be made. There is no theraputty and hand gel is running out, but the therapists are very creative with different local materials!
CRP operates an Inclusive school through their Special Education Needs Unit (SENU). This unit employs one full time Occupational Therapist to cater for the 58 residential and non-residential students studying in different classes in the inclusive unit and special unit. The majority of children have cerebral palsy, however there are also a few children with autism and downs syndrome. Children receive both individual and group therapy to develop their occupational performance. Group sessions include hand therapy and handwriting classes, ADL classes (dressing, drinking, grooming), cooking classes and recreational classes including hippotherapy (horseriding).
Community Based Rehabilitation (CBR):
Currently CRP has no OTs employed in CBR projects; however student placements continue to occur in this area with the supervision of Lecturers from BHPI. The following activities are undertaken by the Occupational Therapists:
Identification of appropriate patients with the help of Community Rehabilitation Therapists in the community health centers.
Continuing treatment sessions with identified patients are provided, resulting in functional and clinical improvements of the conditions. The aim of treatment is to increase acceptance of people with disabilities in their families and societies to facilitates continual recovery, improve functional capabilities as well as relieving the families from financial burden.
Referrals are made for the identified patients to health service providers, where patients are informed and supported to ensure services are continued.
Disability issues are being raised among the local people including local Government administration and local influential persons, resulting for growing awareness and support.
Arranging Multidisciplinary services such as day long health camps in rural areas where people with disability are unable to receive acute and rehabilitation services.
Assisting people with disabilities to get Disability Identity Cards from Govt. local Health administration, which provides extra support and services.
Mobility aids distribution among people with disabilities facilitated through Community Rehabilitation Therapists and OTs. As a result accessibility and mobility is facilitated, which increase familial acceptance, social acceptance and opportunity for financial financial income.
CRP operates a 13 story centre in Mirpur, Dhaka, providing inpatient and outpatient Occupational Therapy services to clients with a range of disabilities. OT's work in:
Stroke Rehab Unit: There are 16 Private cabins and two General wards (male and female) which contains 20 beds. Three Occupational Therapists are working in this unit to ensure Occupational Therapy service to those patients. Though all type of neurological patients are admitted, usually Stroke patients are prioritised in this unit.
Out Patient Services: Clients with different conditions receive Occupational Therapy from this service. Most are stroke patients and hand therapy patients. There are 4 Occupational Therapists who are working in this service. We have recently introduced the Hand therapy service.
Paediatric Unit: There is an Inpatient and Outpatient service offered for paediatrics similar to the service in Savar. There are 11 separate rooms for every child and mother in inpatient services. It is a two week inpatient package for every mother & child. Usually children with Cerebral Palsy have priority in receiving this package, and children with other different conditions are treated in the outpatient service. Five occupational therapists are dedicated to the service in this unit.
Splinting and assistive device Services: Different Hand splints and assistive devices are supplied from this service area.
Domiciliary Service: This is the home based therapy services. The patients who are not able to attend at Centre usually have priority to receive this service. One Occupational Therapist is providing the service under the banner of Domiciliary Service. The current priority locations are Dhaka City at Gulshan, Banani, Dhanmondi, Bardhara & Mirpur.
We are currently working on expanding our areas of clinical work to geriatrics (care of the elderly) at the Mirpur site.
The Bangladesh Health Professions Institute is CRP's academic institute and provides educational programs in Occupational Therapy at a Bachelor, Diploma and Assistant Certificate level. Here, on campus at CRP, the training of Bangladesh's future Occupational Therapists has taken place for the last 15 years with 112 students having graduated from the programs.
Promotional Activities for Occupational Therapy in Bangladesh
CRP is seen as the Mother Institute for Occupational Therapy in Bangladesh and conducts many awareness raising activities to promote Occupational Therapy throughout the country. The Bangladesh OT Association is based at CRP and is also involved in the promotion of the OT profession nationwide. Activities that have been conducted over the years include:
National OT Seminars
Occupational Therapy Week promotional activities, including presentations to the community, schools and colleges about the OT role, and publishing of newspaper articles about OT in Bangladesh
Arranged advocacy to related health organizations and services, to create further job opportunities and expand the OT service/role.
Conducting student placements in emerging/new working areas of OT, for example placing students in psychosocial services where there are currently no OT positions, these placements are supervised by Lecturers at BHPI. (an academic institute of CRP)
International Student Placements:
CRP welcomes any overseas Occupational Therapy students wanting to complete their fieldwork placements with us. Previously we have hosted students from Australia, USA, Germany, Holland, Switzerland, Canada and UK, and are well equipped and trained to complete OT student supervision and education.
We have possess a strong relationship with Australian Volunteer Programs including AYAD & VIDA and regularly have positions available - please visit www.ayad.com.au or www.vidavolunteers.com.au for further information. If you are interested in volunteering or completing a student placement with the OT Department please contact;
Md. Mahfuzur Rahman – Head of OT Department
Mohammad Mosayed Ullah – Course Coordinator & Lecturer
Bangladesh OT Association